the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Sunday, October 12, 2008

i smell drunk people

it's funny how smells can be so emotive. i have spent a fair amount of time in the state hospital lately. and going through casualties the smells were so familiar. it is a smell common, it seems, to all state hospital casualty units that i've ever worked in. and somehow alcohol is the constant thread.

i'm not talking about smelling alcohol on the breath of an aggressive family member, although that is also something one does see (or smell) a lot of. but it is so much more than that. i'm talking about the residual smell of alcohol laced bodily fluids after a busy trauma night. it is a smell that is resistant to being washed out.

it's difficult to explain but the smell left me with a longing for days gone by when i was the surgical registrar on the floor. i was the guy placing the nasogastric tube when the patient brings up the night's festivities all over the bed and often my shoes, leaving a sour smell of alcohol and stomach acid. when i was the one placing a high flow line into the neck of the nth drunk uncooperative gunshot wound patient, where part of the technique is to dodge his often well placed punches. in those moments you are not aware of the smell. maybe the adrenaline drowns it out. but it is always there. the next day when you walk into casualties and the smell hits you, the nigh's activities return so vividly to your mind.

i remember when i first learned the smell of alcohol in blood. strangely enough it was during an operation on a sober gunshot patient. he was bleeding profusely. i kept on thinking there was something missing. the blood didn't smell right. and then i realised that the smell i was missing was the smell of alcohol in the blood. how weird is that to know what alcohol in blood smells like.

yes i miss those days sometimes. alcohol doesn't play that prominent a role in private but you still see it. so it was a nice trip down memory lane this weekend to smell that smell again.

p.s the patient at the state hospital this weekend survived and was even extubated the next day.

Early in my career, I saw a lot of end stage renal disease patients. To this day I can walk through the emergency department and catch a whiff of uremia that takes me back. It is funny how smells seem to be so closely tied with memory.

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.